Even before the floodwaters had receded from Superstorm Sandy, the New York City Health and Hospitals Corporation was planning a massive planning effort to prepare for the next big storm.

Every aspect of hospital operations had to be reevaluated -- from communications to food service, linens to medical supplies. Every element of patient care, staff schedules and transportation would be examined to see what worked well and what needed improvement.

Bellevue and Coney Island hospitals, in particular, were hit hard and had to be evacuated during the storm. Coler Specialty Hospital was flooded and lost power and steam heat. Metropolitan Hospital experienced flooding and nearly lost its main generator. Other HHC hospitals and clinics outside the flood zones also endured damage from wind and flooding, and hundreds of staff worked extra hours and stayed overnight, sleeping in between shifts to ensure coverage for the next day, even as their own homes and families were being affected by the storm.

While the evacuations of Bellevue and Coney Island went relatively smoothly, with no patient fatalities or injuries, HHC President Alan Aviles is buoyed by the knowledge that if such a powerful storm should happen again, the system will be better protected.

"There's been a flurry of activity over the last 10 months not only to clean up, restore, rebuild and replace so many of the areas that sustained damage from Sandy, but also to be better prepared for the next one," said HHC President Alan Aviles. "Our priority has been to harden physical plants, ensure that critical systems can remain operational, and prepare for the needs of patients and staff during future weather events."

Infrastructure improvements

At Bellevue, where an estimated 8.5 million gallons of water entered the basement through loading docks facing the East River, the reconstruction plan includes relocating key parts of the electrical distribution system to the first floor. While most emergency generators are already on high floors, fuel pumps for the generators and drinking-water system pumps will need to be relocated to higher floors as well.

Units designed for outdoor use, so they can more easily return to service after water exposure, have replaced damaged heating and air conditioning systems. Medical gas systems will be re-engineered to withstand flooding, and some of the crucial elevator shafts will be shielded and pumps will be installed so that vertical transportation within the hospital – a serious problem during Sandy when all 32 elevator shafts were flooded – can continue operating.

HHC also examined how to keep water out of all of its facilities, a seemingly impossible task in the face of massive storms: Both Bellevue and Coney Island hospitals have new, temporary barricade systems and flood walls that can be installed on a few hours' notice. At Coney Island, the system is designed to protect not only the emergency generator in the parking lot, but also key entrances and the first floor Emergency Department, which Sandy severely damaged.

Mental health counseling

Administrators also are addressing the mental-health impact on staff. Bellevue Executive Director Steve Alexander says that dealing with the psychological impact on staff was even more complicated than making repairs and preparing facilities for future events.

"The impact of Sandy is long-lasting in people's minds," says Alexander. "The reactions we see are similar to Post-Traumatic Stress Disorder. In the future, we'll be ready with the right mix of counseling services that may be necessary for staff after the crisis."

Communications upgrades

"We lost power, lost cell phones and lost landlines during Sandy," says Coney Island Hospital's Executive Director Arthur Wagner. The post-Sandy assessment process pointed to communications as the area most in need of improvement, he said.

"Radio repeaters throughout Brooklyn stopped working. We were able to reach Kings County Hospital by radio during the storm and that became our main line of communication. We're now testing satellite phones which don't rely on cell towers or copper phone lines," Wagner said.

HHC's central office executive leadership team, which works closely with the city's Office of Emergency Management and oversees the response for the entire 11-hospital system, also lost power at its central office building on Worth Street during Sandy, forcing the staff to disperse all over the city while running the response effort. To support centralized operation in a future emergency, HHC will be ready with the following new equipment and practices:

A new back-up generator system for the office headquarters building;

A new communications system that sends alerts to many people simultaneously and works its way through email addresses and phone numbers until the person acknowledges receipt of the message;

A new web-based incident command system to connect the central office and hospital-based command centers that can track and prioritize requests for supplies and other resources.

In the event of evacuations, HHC hospitals also will participate in the new E-Finds Health Commerce System, which was created by the state Department of Health to help locate available beds and track patients evacuated in an emergency. Staff from throughout HHC, not just from the hospitals most at risk, have been trained to use the new system as an extra precaution. Everyone hopes it won't be necessary.